BACKGROUND: This study aimed to explore the feasibility and histological basis of pancreatic two-dimensional shear wave elastography (2D-SWE) measurement in predicting post-operative pancreatic fistula (POPF) following partial pancreatectomy and to build a prediction model by pre-operative features. METHODS: 305 pancreatic or periampullary disease patients were enrolled, divided into a training (n = 203) and a validation group (n = 102). POPF was graded as A (or the so-called “biochemical leak”), B, and C. Spearman correlation analysis assessed the histological basis of 2D-SWE measurement value’s (Emean’s) relationship with POPF grades. Multivariate logistic regression analyzed risk factors of POPF occurrence in the training group, and a predictive model was built. The discrimination ability of the model to differentiate POPF grades was analyzed by the area under the receiver operating characteristic curve (AUC). RESULTS: Emean could discriminate between the occurrence and grades of POPF (all AUC > 0.75, p < 0.050). Pancreatic fibrosis and acinar atrophy correlated with both Emean and POPF (all p < 0.050). The higher BMI (p = 0.002), non-dilated pancreatic duct (p = 0.001), and lower Emean (p < 0.001) were the independent risk factors of POPF occurrence and could help discriminate the occurrence of different grades of POPF in both groups (all AUC > 0.80, p < 0.050). CONCLUSIONS: Lower pancreatic 2D-SWE measurements indicated a higher risk of POPF, and the histological basis may lie in 2D-SWE’s correlation with pancreatic fibrosis and acinar atrophy. A model integrating pancreatic 2D-SWE measurements, BMI, and the presence of pancreatic duct dilation could predict POPF risk across varying severity levels.
Keywords: Pancreas stiffness; Post-operative pancreatic fistula; Two-dimensional shear wave elastography.